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List the four lobes located in the cerebrum and explain their functions.
- 1) Frontal Lobe - impulses for voluntary movement
- 2) Parietal Lobe - interprets cutaneous sensations
- 3) Temporal Lobe - auditory and olfactory area
- 4) Occipital Lobe - vision
Name the Parenteral routes of administration
- 1) Intraocular - eye drops
- 2) Intranasal - nose spry
- 3) Inhalation - inhaler
- 4) Intravenous - direct to blood stream
- 5) Intramuscular - Into the muscle
- 6) Intradermal - under the skin
- 7) Subcutaneous - beneath the skin
- 8) Topical - ointments
Name the Enteral routes of administartion
- 1) Oral (PO)
- 2) Buccal
- 3) Sublingual (SL)
- 4) Rectal (PR)
Through the GI Trac.
What are the different types of drug variation factors?
- 1) Age
- 2) Weight
- 3) Gender
- 4) Emotional state
- 5) Genetics
- 6) Concomitant Diseases
In what way can a drug leave your body?
- 1) Through the GI tract
- 2) Respatory system
- 3) Renal system
List the steps in Pharmacokinetics. What is Pharmacokinetics?
- 1) Absorption - Drug enters the blood stream
- 2) Distribution - Hot the chemical gets there
- 3) Metabolism - How it breaks the chemical down
- 4) Execration - How your body gets rid of chemicals
Pharmacokinetics is the movement of the drug throughout the body.
Explain drug naming.
1) Chemical - scientific name, a drug can only have 1 scientific name.
2) Brand - Proprietary name given by drug manufacturer.
3) Generic - Active ingredient.
4) Official - Name in references, usually generic
What is direct toxicity?
1) Reaction to medication that results in direct damage of the tissue.
What is drug dependence?
1) Patience with drug dependence need to maintain the drug to function normally.
What is a Toxic Effect and what should be done?
- 1) It is a harmful or lethal effect.
- 2) Patient should quit taking drug.
What does Narrow TI mean?
1) It means that a patients blood levels need to monitored.
What is Potency?
1) Measurement of strength or concentration for the drug to produce a specific effect.
What is the Therapeutic Index (TI)?
- 1) Ratio of LD50 (lethal dose) and ED50 (effective dose.
- 2) Gives relative safety of a drug
- 3) Narrow TI
List the different types of topical's.
- 1) Cream, ointments, gels, lotions
- 2) Powder
- 3) Lineaments - Liquid preparation for external use that is rubbed on as a counter irritant, may produce heat.
- 4) Trans-dermal
- 5) Aersol
What are the different types of oral medication?
- 1) Tablet/Capsule
- 2) Syrup
- 3) Lozenges
- 4) Emulsions
- 5) Extended/Delayed Release
Name the different effects of drugs
- 1) Therapeutic Effect - Intended effect
- 2) Side Effect - Unintended effect
- 3) Adverse Effect - Often an exaggeration of the intended effect
- 4)Toxic Effect - Extremely harmful effect
Coordinates body movements and posture, helps maintain equilibrium.
Group of cell bodies within the cerebrum that control certain subconscious aspects of voluntary movement.
1) Basal ganglia
Composed of myelinated axons that conduct nerve impulses to and from the cerebral cortex.
1) Cerebral white matter
Largest and uppermost part of the brain.
Regulates sensory impulses traveling to the cortex.
Controls cardiac, vasomotor, and respiratory functions.
1) Medulla oblongata
Controls the body's higher intellectual and voluntary activities.
1) Cerebral cortex
What is an opioid?
1) Drug that produces the same pharmacological effects as opium and its family of drugs or the neuropeptides (enkephalin, endorphin) produced by the body.
Describe and antitussive effect.
The antitussive effect is produced by direct inhibition of the coughing center in the medulla.
Define opioid antagonist.
A drug that attaches to opioid receptors and displaces the opioid analgesic or opioid neuropeptide.
What is the opposite of euphoria?
The production of only a small amount of urine?
The production of no urine?
A substance that inhibits one's reaction to pain.
How do the nonopioid analgesics differ from the opioid analgesics?
- 1) These analgesics are not chemically or structurally related to morphine.
- 2) They are non effective against severe, sharp (visceral) pain.
- 3) They produce analgesia through both a CNA and a peripheral mechanism of action
- 4) They do not produce tolerance or physical dependency with chronic use.
Decreased response to pain.
Explain the term inflammation.
Condition in which tissues have been damaged, characterized by swelling, pain, heat and sometimes redness.
What is joint pain?
What pain is associated with muscle injury?
Inflammation of the joints.
Small area of skin or mucous membrane that is discolored because of localized hemorrhages.
Condition in which pain and inflammation of joints are accompanied by elevated body temperature.
Condition in which toxic doses of salicylates result in nausea, tinnitus, and delirium.
What does CNS stand for?
Central Nervous System
What does PNS stand for?
Peripheral Nervous System
What are neurons?
Basic nerve cells
What are the 2 different types of neurons?
- 1) Excitatory - transmits impulses
- 2) Inhibitory - don't transmit impulses
What is a the Synapse?
Small gap between end of one neuron and the cell body of another.
What is the Ganglion?
Group of neuron cell bodies located outside of the CNS.
Sensory or Afferent do what?
Carry impulses from receptors to CNS
What is Visceral?
Motor or Efferent do what?
Carries impulses from the CNS to effectors.
What do effectors do?
The cause muscles to contract or relax
What is the PNS?
It is a combination of sensory neurons and monot neurons.
What does the spinal cord do?
Transmits impulses to and from the brain.
What are the two tracts of the spinal cord and what do they do?
- 1) Ascending tracts carry sensory impulses to the brain
- 2) Descending tracts cary motor impulses away from the brain
How may different pairs of spinal nerves are there?
What is the Medulla?
The Medulla regulates cardiac, vasomotor, and respiratory functions; reflex center for coughing, sneezing, swallowing, & vomiting.
What are Pons?
Pons work with the medulla to produce normal breathing patterns.
What does the Hypothalamus do?
It is responsible for maintaining homeostasis.
What are the two divisions of the Autonomic Nervous System (ANS)?
- 1) Sympathetic
- 2) Parasympathetic
Sympathetic and parasympathetic nervous consist of motor portions of some cranial and spinal nerves, what are they?
- 1) Visceral - smooth muscles, cardiac muscle and glands
- 2) Effectors - cause muscles to contract or relax
What is Flight or Fight?
It is your sympathetic neurotransmitter or adrenalin which produce both norepinephrine and epinephrine.
What is AcH?
- 1) Part of the parasympathetic system
- 2) Inactivated by acetylcholinesterase or cholinesterase
- 3) Reverses most of the effects of NE and EPI after flight or fight situation
Why is Dopamine important in the body?
- 1) A balance of Dopamine and AcH are responsible for fine motor movements.
- 2) Parkinson's disease may result form dopamine deficiency.
What is the chemical name for Serotonin?
List 2 drugs that enhance the actions of GABA, and what do they treat?
- 1) Benzodiazepines (BZDPs)
- 2) Barbiturates
They treat anxiety and seizures
What are the 2 components of Pain?
- 1) Physical
- 2) Psychological
List the factors that lower your pain threshold.
- 1) Anxiety
- 2) Sleeplessness, Tiredness
- 3) Discomfort, Pain
- 4) Anger
- 5) Fear, Fright
List the factors that increase your pain threshold.
What are the 3 pain classifications?
- 1) Acute - severe discomfort with sudden onset
- 2) Chronic - pain that has been lasting for more than 6 months
- 3) Psychogenic - somatic pain arising from psychiatric illness or psychosocial issues
What are Opioids?
Narcotic analgesics derived from opium or have opium-like effects.
What are the 3 classifications of Opioids?
1) Agonists - drugs that bind with the receptor to activate and produce the maximum response.
2) Partial agonists - binds to receptor but produces a partial response
3) Mixed agonists-antagonists - is a drug that acts as an agonist to one type of receptor and competitive antagonist at another, which produces a mixed response.
What are the primary Opioid receptors in the CNS called?
Primary opioid receptors in the CNS are the mu, kappa, delta and sigma.
What are the 5 opioid agonists?
1) Morphine (CII) - can be used in detoxification
2) Codeine (CII) - available as oral tablets, oral solutions, and injectable dosage forms.
3) Methadone (Dolophine) (CII) - approved for use in state approved detoxification and maintenance treatment programs.
4) Fentanyl (CII) - Available as preservative free solution (Sublimaze) or as a topical Transdermal Patch
5) Tramadol (Ultram) (not a controlled substance)
What are Opioid Antagonists?
Antagonists block subjective and objective opioid effects and can precipitate withdrawal symptoms in individuals physically dependent on opioids. They are used to reverse the adverse or overdosage effects of opioids and partial agonists.
What are 3 specific Opioid Antagonists?
- 1) Nalmefene (Revex)
- 2) Naloxone (Narcan)
- 3) Naltrexone (ReVia)
What are non-opioid analgesics effective for?
Non opioids are effective for mild to moderate pain and are often combined with opioid analgesics to enhance pain control in patients with severe pain
What major drugs in the Non-Opioid class?
- 1) ASA (asprin)
- 2) APAP
- 3) NASAIDS (Non-Steroidal anti-inflammatory drugs)
What are some of the side effects and adverse effects of NSAIDs?
- 1) Skin rash and pruritus
- 2) Heartburn, nausea, vomiting
- 3) Dizziness, drowsiness
- 4) Gastric pain, distress or ulceration, GI bleeding, perforation
- 5) Nephrotoxicity, tinnitus
What are the contraindications to NSAIDs?
Avoid use in patients with history of hypersensitivity or a severe allergic reaction to asprin or other NSAIDs, asthma, severe renal or liver disease, and ulcer disease.
Stages of Anesthesia
- 1) Analgesia: begins with onset and lasts until loss of consciousness.
- 2) Excitement
- 3) Surgical Anesthesia
- 4) Medullary Paralysis (Toxic Stage)
Special considerations for anesthesia
- 1) Alcoholism
- 2) Obesity
- 3) Smoking
- 4) Pregnancy
- 5) Young age
- 6) Advanced age
List the inhaled anesthetics and their uses
- 1) Gases Nitrous Oxide (N2O) - Most commonly only used agent for dental surgery, minor surgery, and obstetric analgesia.
- 2) Volatile Liquid Anesthetics - primarily as a general anesthetic.
Describe advantages to Intravenous Anesthetics
Intravenous Anesthetics - Advantages are rapidly induces unconsciousness, amnesic effects, prompt recovery with minimal doses, simplicity of administration, non irritating to mucos mumbranes.
IV Anesthetics - Non-Barbiturates
- 1) Benzodiazepines
- 2) Midazolam CIV(Versed)
Ketamine - dissociative anesthesia is characterized by analgesia and amnesia without loss of respiratory function or phryngeal or laryngeal reflexes
Pre-anesthetics or adjunctives
- 1) Preanesthetic agents/anesthetic adjunctive agents
- 2) Anticholinergics: Glycopyrrolate (Robinul) - inhibition of secretions, vomiting and laryngospasms,
Local Anesthetics - Topical
Surface or topical anesthesia - commonly used are the following: Benzocaine (Americaine) Lidocaine (Xylocaine, Lidoderm) Tetracaine (Pontocaine, Synera)
Anti-anxiety agents are also called?
1) Anti-anxiety agents are also called anxiolytic agents
Anxiety is a state or feeling of apprehensions, useasiness, agitations, uncertainty and fear resulting from the anticipation of some threat or danger
What have Barbiturates been replaced by?
BZDPs - Binds to receptor adjacent to GABA receptor which results in GABA remaining at it's site.
Describe ways barbiturates can be absorbed
- 1) Oral
- 2) Rectal
- 3) Parenteral administration.
List cautions of barbiturates
As a class they interact with over 40 other drugs.
Long Acting Amobarbital
Used as a hypnotic for daytime sedation and for pre-op sedation.
Used as a hypnotic for daytime sedation and as a anticonvulsant; Available PO and IV, IM, SC
Among the most widley prescribed drugs primarly because of their advantages over the older drugs.
Most common indications include anxiety disorders, alcohol withdrawal, preoperative medication, insomnia, seizure disorders, and neuromuscular disease.
- 1) Alprazolam
- 2) Chlordiazepoxide - used in alcohol withdrawl
- 3) Clonazepam
- 4) Diazepam
- 5) Flurazepam - approved as a sedative hypnotic in patients older than 16. Available PO
- 6) Temazepam - must be over 18
Flumazenil - indicated for treatment of BZDP overdose or to reverse the sedative effects of BZDP after surgical or diagnostic procedures.
Buspirone - said to be equivalent to the BZDP bu with less sedation
Hydroxyzine - Actually an antihistamine, it is also used as an Antianxiety agent, sedative hypnotic and antiemetic.